This article was downloaded by: [Moskow State Univ Bibliote] On: 10 February 2014, At: 00:14 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Media Practice Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rjmp20 It's good to talk? Talking Cure and the ethics of on-screen psychotherapy Lesley Blaker a a University of Salford Published online: 06 Jan 2014. To cite this article: Lesley Blaker (2013) It's good to talk? Talking Cure and the ethics of on-screen psychotherapy, Journal of Media Practice, 14:3, 193-209 To link to this article: http://dx.doi.org/10.1386/jmpr.14.3.193_1 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms- and-conditions
Transcript
This article was downloaded by: [Moskow State Univ Bibliote]On: 10 February 2014, At: 00:14Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Media PracticePublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/rjmp20
It's good to talk? Talking Cure and theethics of on-screen psychotherapyLesley Blakera
a University of SalfordPublished online: 06 Jan 2014.
To cite this article: Lesley Blaker (2013) It's good to talk? Talking Cure and the ethics of on-screenpsychotherapy, Journal of Media Practice, 14:3, 193-209
To link to this article: http://dx.doi.org/10.1386/jmpr.14.3.193_1
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.
This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
This article considers the ethical concerns facing media practitioners who make programmes which feature on-screen psychotherapy. Psychotherapy is convention-ally regarded as a confidential activity involving the participation of ‘vulnerable’ people. These qualities combine to produce particular ethical dilemmas for practi-tioners who make programmes about psychotherapy. These dilemmas are explored through an analysis of the UK television documentary series Talking Cure, which follows a number of people through psychotherapeutic assessment at a well-known clinic. Although the series was considered by some within the television and psycho-therapy communities to be ‘groundbreaking’, its critical reception exposes the ethi-cal pitfalls facing media practitioners (and psychotherapists) who work on such programmes. In the current UK factual television landscape, particularly in light of developments within the lifestyle television genre, the participation of psychologi-cally or emotionally vulnerable people is relatively commonplace, and the involve-ment of psychotherapists who deliver psychotherapeutic treatment is not unusual. This article identifies the potential risks facing media practitioners who engage in this kind of programming. While professional codes provide guidance on how to negotiate ethical dilemmas, it is the individual media practitioner who must negoti-ate the challenges which emerge when the rights of vulnerable programme contribu-tors are pitched against the demands for ‘good television’.
It has been said that it is impossible to engage in documentary film-making ‘without stubbing one’s toe on ethical questions’ (Nash 2011: 224). Such questions are particularly pressing in the context of contemporary UK factual television production, which has seen a gradual shift since the 1990s towards ‘approaches that underscore the personal, sensational, the subjective, the confessional, the intimate’ (Dahlgren 2005: 416). The emergence of reality TV and lifestyle television has generated such an increased demand for the involvement of ‘ordinary’ people in programme content that ‘[p]ublic partici-pation now constitutes a regular feature of television programming’ (Hibberd et al. 2000: 79). With such developments comes a concomitant increase in ethical dilemmas for programme-makers. It has been argued that ‘[n]owhere are the ethical responsibilities of documentarists more acutely felt than in the putting together of documentary accounts where people are interviewed about traumatic or life-changing events’ (Kilborn 2004: 29). While this descrip-tion might be applied to any television documentary which features people whose personal circumstances are in a state of flux, it is perhaps most relevant to programmes which bring together psychologically or emotionally vulner-able people with psychotherapists in projects designed to facilitate personal and therapeutic change.
While the making of programmes which feature on-screen psychother-apy is a niche area of UK factual television, there has been a steady increase in this kind of programming during the past decade. This development has strong associations with the emergence of lifestyle television. This genre has been described as ‘a portal to transformation’ (Palmer 2008: 12) in which the programme contributor is required to ‘surrender … the self to the scrutiny of the expert, the programme and to viewers’ (Biressi and Nunn 2008: 23). Of particular relevance is the life experiment programme in which programme contributors embark on projects designed to address and resolve their personal and emotional problems. The resultant programmes portray their ‘tensions, triumphs and failures … in an observational manner’ (Hill 2007: 50). This sub-genre includes programmes such as The Hoarder Next Door (Channel 4 2012), which features the psychotherapeutic treatment of people with hoard-ing disorder, and House of Obsessive Compulsives (Channel 4 2005) and House of Agoraphobics (Channel 4 2006), in which people with anxiety disorders undergo on-screen psychotherapy.
Any programme which features on-screen psychotherapy presents poten-tial risks to the well-being of programme contributors due to the relative lack of anonymity compared with other mass media. This, in turn, presents greater challenges to the programme-maker. While it is broadcasting institutions that create professional guidelines and codes of conduct, the responsibility for their implementation lies in the hands of individual programme-makers. This article considers the ethical concerns facing media practitioners who make programmes which feature on-screen psychotherapy. It uses as a basis for its discussion a case study of the UK television documentary series Talking Cure (BBC Two 1999). This series was selected for analysis for two reasons. First, as a six-part series, it presents substantial footage of on-screen psycho-therapy with a number of different psychotherapists and ‘patients’. Second, the timing of its production and broadcast – the late 1990s – places it at the start of significant developments in UK factual television. While Talking Cure is undoubtedly an example of ‘traditional’ television documentary, and is a
programme with a clear remit to represent the psychotherapeutic process in a serious, in-depth way, there are, nonetheless, moments within the series which anticipate the more entertainment-driven approaches to the represen-tation of on-screen psychotherapy which have since been broadcast.
Throughout this article, I will use the terms psychotherapy and psychothera-pist in a general sense rather than in reference to any particular psychothera-peutic modality. I will also use the term patient to refer to those programme contributors who undergo on-screen psychotherapy sessions. This rather conservative term has been chosen for purely pragmatic reasons, to be consist-ent with the use of the term in the programme and much of the literature. I will not be judging the quality of the psychotherapy being offered, nor engag-ing in the diagnosis of programme contributors’ mental health. Instead, my aim is to focus on the ethical dilemmas which confront media practitioners when they engage in programming which feature on-screen psychotherapy.
Talking Cure
Talking Cure is a six-part documentary television series about the work of the Tavistock Clinic in London, described (in the programmes) as the UK’s larg-est NHS psychotherapy centre. At the time of its broadcast, the series was promoted by Jane Root, the then newly appointed BBC Two controller, as ‘a painstaking and groundbreaking series which unveils the therapeutic process for the first time on British television’ (M2 1999). The significance of the series was acknowledged within the psychotherapeutic community. The editorial column of the British Journal of Psychotherapy described it as a ‘rare chance’ (Arundale 2000a: 145) to view the therapy process; a prac-ticing psychotherapist writing for the same journal commented that ‘(t)he Tavistock’s decision to allow their work to be filmed and presented on TV is a breakthrough for psychoanalysis and psychotherapy, and represents a major move towards greater openness to and engagement with the world at large’ (Marks 2000: 75). Talking Cure also made its mark among television critics. The series was described as ‘galvanising viewing’ (Kellaway 1999b). One critic commented that although it was ‘hard to justify being present as a voyeur in such an intimate setting … you’ll be glued to your seat offering your own diagnoses nonetheless’ (McGill 1999). Another wrote that he was ‘enjoying these programmes almost as much as Tony Soprano’s scenes with the divine Dr Melif’ (Billen 1999).
The series was made by BBC Documentaries with funding from BBC Education (BFI 1999) and was broadcast weekly on BBC Two at 9.50 p.m. on a Tuesday evening throughout November and early December 1999. Each 40-minute episode focuses on a different aspect of the work of the Tavistock Clinic. In the first and sixth episodes, a psychotherapist from the Tavistock’s Trauma Unit conducts psychotherapeutic assessments of a young man and a married couple who are living with the psychological and emotional conse-quences of a fatal traffic accident. The first episode of the series corresponds most closely to the popular image of psychotherapy: two people sitting together in a room, one talking and the other listening, even though this episode is dominated by extracts in which the psychotherapist talks as much, if not more, than her patient. The second and fourth episodes show extracts of family therapy sessions, a mode of working which feels, in comparison to the traditional therapeutic dyad, ‘quite alien’ (Dodge 2000: 175). The second episode shows one therapist observing through a two-way mirror as her
colleague conducts the session with the family, occasionally returning to the room to discuss the progress of the session with her colleague in front of their patients. The third episode explores the clinic’s work with organizations, in this case a Welsh primary school where the headmaster is concerned about stress levels among teaching staff. In this episode, the psychotherapist visits the school to conduct the assessment. The fifth episode does not involve any actual psychotherapy but looks instead at the role of infant observation in the training of Tavistock psychotherapists.
No media personnel were present in the therapy rooms during the Talking Cure sessions themselves, which were recorded remotely using three cameras. There is footage which shows the camera outputs being fed through to a vision-mixing desk in an adjoining room. A large two-way mirror separates the two rooms. The only reference to the cameras within the series itself is in the third episode when Conor, the child in one of the family therapy programmes, dislodges a camera plug making the screen go black.
MedIa InterventIons In the therapy process
‘Documentary [is] … about much more than simply recording reality; there has always been an interpretational, reality-bending side to documenta-rists’ work’ (Kilborn 2004: 29). When media practitioners make programmes which involve on-screen psychotherapy, they intervene in and impact upon the psychotherapy process in a number of ways. The selection of patients and psychotherapists, otherwise known as ‘casting’, the recording of therapy sessions (whether by ‘hidden’ cameras or otherwise) and the editing of the resultant therapy session footage all shape the psychotherapy which is even-tually presented as programme content.
At the start of each Talking Cure episode, the voice-over states that the people taking part in the filmed psychotherapeutic assessments were selected after responding to advertisements placed by the BBC in specialist publica-tions, such as The Times Educational Supplement (Wallace 1999). Advertising is the most common approach to finding contributors for programmes which feature on-screen psychotherapy, although these days researchers would be more likely to use mental health websites and forums. An alternative approach is to find people who are already undergoing psychotherapy and negotiate access to their sessions. The Tavistock clearly considered this but stated that it ‘did not feel it would be possible to make programmes about ongoing psycho-therapy without disrupting the process’ (Temple 2000: 273). This stance is not untypical. The psychotherapist involved in House of Obsessive Compulsives and House of Agoraphobics ‘never fields his own patients … [because] they come to him for help, not to be on television’ (Cassidy 2006: 1275). Talking Cure is not explicit about how it finally selected the people who appear in the series, though the desire to reflect the range of work conducted by the clinic will have been a factor in their selection.
Unsurprisingly, psychological research has shown that the use of recording equipment – whether cameras or tape recorders – during therapy sessions can impact upon feelings and behaviours within the therapy room. The presence of cameras, for example, can lead people to visualize themselves on a televi-sion screen, or imagine an audience viewing what is being recorded. However, it has also been observed that reactions of this kind may lessen with repeated exposure (Ford 2008). There is anecdotal evidence suggesting that people who take part in programmes which use remote cameras, such as long-form
fixed-camera observational series like The Family (Channel 4 2008–2010), do, at least occasionally, forget about the presence of the cameras. One contributor in the first series of The Family reported that ‘[w]hen I was alone, making a cup of coffee or folding the washing, I’d hear the remote-control cameras moving and suddenly think, “Oh, they’re watching me” ’ (Haynes 2008).
In any case, the presence of cameras within the therapy room is not unusual; the recording of therapy sessions is routinely used as part of the train-ing process for psychotherapists (Schwartz 2000). Psychotherapists, therefore, are likely to have experience of being filmed and will be familiar with seeing or hearing recorded versions of themselves. From an ethical point of view, this gives psychotherapists an advantage over other programme contributors, including those who are participating as their patients. However, while this advantage is enhanced in cases where the patients have had no prior experi-ence of psychotherapy, it may also be minimized in cases where the contribu-tors participate in long-term projects like Talking Cure.
This imbalance in the level of familiarity with being filmed may partly explain why Talking Cure psychotherapists review their work, sometimes criti-cally, in interviews conducted separately from the assessment sessions. For example, the psychotherapist in the first episode says,
whatever mistakes you make, and I did make mistakes in those consul-tations with [Jan], I know I did, because I was too abrupt and too hurried and rushing him along and and also offering opinions on certain things which I wouldn’t, I wouldn’t think was good technique.
The inclusion of this kind of material reflects one of the decisions taken by the programme-makers at the programme’s editing stage. Each Talking Cure episode is structured so that the psychotherapy sessions are presented in chronological order, interspersed with extracts from interviews with patients and psychotherapists, with actuality sequences featuring some aspect of the patients’ personal life beyond the Tavistock, and with extracts from supervi-sion sessions, in which the psychotherapist discusses the patient(s) with his or her colleagues. There are also some short informative voice-over sequences about the history and work of the Tavistock Clinic.
As with any documentary programme, high shooting ratios on Talking Cure mean that that the majority of footage has been left out of the finished programme. The voice-over states that the Talking Cure series was shot over a 2-year period, and the psychotherapy footage alone, for each 40-minute episode, amounts to something in the region of 240 minutes’ worth of unedited material (calculation based on four 60-minute sessions). Approximately half of each episode is given over to the therapy sessions – around 20–25 minutes screen time – representing around 10 per cent of the overall therapy session material. The process of selecting and assembling extracts while respecting the integrity of the content and pacing of the original material is a funda-mental part of the television documentary editing process. It is inevitable that material will be left out which could have been useful to the programme, or that the pacing of events may have been modified to meet the requirements of programme structure or duration.
It has been argued that Talking Cure illustrates ‘the need to dramatize and narrate what is essentially an untidy process’ (Orbach 2000: 51). Certainly, when so much raw material has been recorded, a clear and decisive editing strategy is required. It has been observed that the editing of the psychotherapy
sessions in Talking Cure reflects a preoccupation with ‘the content of patient’s communications [rather than] … the process of interaction, the transfer-ence/countertransference that is going on between patient and therapist’ (Hinshelwood 2000: 54) [original emphasis]. However, the same author acknowledges ‘[t]here are a number of sequences … where we get some interaction between the two parties (though sometimes it is a bit difficult to know if something has been edited out)’ (55). As a consequence, it is argued, ‘the programme failed to show the full nature of conflict in therapy’ (57).
While it might be understandable why some psychotherapists have been critical about how the psychotherapy in Talking Cure is represented, the debate about the verisimilitude of the psychotherapy shown is in some ways irrelevant. As White (1992: 9) has argued, what we see on the television screen is not actually psychotherapy, but a ‘private exchange between two indi-viduals … reconfigured as a public event’. In other words, what is shown in Talking Cure cannot be taken as psychotherapy in any straightforward sense, but only as a representation of it: ‘what we see is no less a construction than any other processed version of a therapy session. The BBC has edited its foot-age to create what the film-makers feel will be a watchable, lively programme’ (Schwartz 2000: 51).
BreachIng therapeutIc confIdentIaLIty
One significant difference between psychotherapy and televised versions of it is in their respective levels of confidentiality. Confidentiality is the most funda-mental tenet of psychotherapy and is so well established that it ‘has achieved the status of a given’ (Wulff, St George and Besthorn 2011: 200). The belief that confidentiality is ‘utterly necessary for effective psychotherapy’ (Yeo and Brook 2003: 85) is challenged in Talking Cure. Not only are psychotherapy sessions broadcast but so are extracts from interviews with psychotherapists in which the patients are discussed, as are extracts of supervision sessions in which psychotherapists discuss their patients with colleagues. While the programme contributors will have agreed to these arrangements, what is less clear is the degree to which they were able to think through the consequences of such a decision. ‘What will others think of you? How will they judge you? What aspects of your life may stand revealed that you had not anticipated?’ (Nichols 2001: 6).
The decision to allow the filming of psychotherapy assessments at the Tavistock Clinic, even though existing Tavistock patients were not involved, produced critical commentary from within the psychotherapy community:
Neither psychotherapy nor psychoanalysis are spectator sports … Therapy sessions, despite supervision and clinical seminars, are extremely private matters … it is quite a paradox that a first glimpse at the inside of a session from … the Tavistock comes from one made for a million people.
(Orbach 2000: 51–52)
why partIcIpate In on-screen psychotherapy?
While the Tavistock Clinic has been explicit about participating in the Talking Cure series in order to ‘advance public knowledge and political debate about psychotherapy and its central place in mental health services’ (Temple 2000: 274), what is less clear is why individual people agree to take part in
on-screen psychotherapy, given the ‘undisguised and highly public exposure that comes from being on television’ (Marks 2000: 76). Research into why people take part in television programmes suggests that motivations can be a ‘complex affair’ (Hibberd et al. 2000: 51). In some instances, programme contributors are motivated by a need or desire to tell their story, and feel they ‘might derive therapeutic benefits from their involvement’ (Hibberd et al. 2000: 53). According to the Tavistock, at least some of the Talking Cure contributors ‘felt that this gave them the opportunity to find help that they did not believe was easily available to them’ (Temple 2000: 273).
The question of why someone would choose to undergo on-screen psychotherapy is addressed directly in the first assessment session of the first Talking Cure episode, where the psychotherapist questions the motives of her patient, a young man called Jan, who caused the death of another motorist in a road traffic accident some years earlier. The positioning of this exploration of why someone would agree to undergo on-screen psychotherapy in the first episode of a six-part series is likely to be deliberate.
Psychotherapist: What I wonder is whether the fact that you’ve come to see me through the possibility of being on a television programme is a kind of hope that if you can actually see yourself, you can look at your-self as if you were looking at another person, that you will somehow see something that, at the moment, you’re lost in relation to. You can’t see it, you don’t know what’s going on.
Jan: No, that wasn’t – I mean what caught my eye about this was just this ‘understanding trauma’. That’s that’s why I rang it up. As far as the television goes side of it, I thought about that up until about half past two today trying to understand that and that was … you know, lots of people have these experiences and lots of people don’t talk about it. I haven’t talked about it properly.
Psychotherapist: That’s partly because you don’t know what to say about it.
Jan: No, I don’t know what to say about it. And I think that there’s an awful lot of other people out there like that – so that’s as far as the television goes …
Psychotherapist: You’re saying it was a sort of altruistic thought. You thought if I talk about this experience it’ll help others?
Jan: As far as the television part of it goes, yes.
Psychotherapist: Rats.
This ‘confrontational moment’ (Nicholson 1999), and the psychotherapist’s ‘quite shocking but calculated response’ (Arundale 2000b: 59), was much commented on afterwards. ‘I couldn’t say I much cared for his therapist … whose quality of mercy was always being strained (Rats! she’d splutter, when he gave the wrong answer)’ (Billen 1999: 57). Whatever the motive behind Jan’s decision to undergo on-screen psychotherapy, the inclusion of this extract, which shows his explanation being unpicked by a ‘highly-trained analytic mind’ (Arundale 2000b: 57), is ethically questionable. While such confronta-tion may be psychotherapeutically appropriate, and is not being conducted directly by the programme-maker, it nonetheless works for the programme
narrative by setting up a mystery which needs to be solved. It is no surprise, then, that the episode includes extracts from the psychotherapist’s supervision group which continue to question Jan’s motives.
Colleague 1: So the question that’s still around for me is why he’s taken this route and I wondered about an element that’s slightly more masochistic. Might be me being a bit pessimistic, I don’t know, but I wondered about that element really.
Colleague 2: [indistinct] what your thoughts were in the first meeting when you were worried was he doing this to make it a public trial and would he end up being either judged or I can’t remember …
Psychotherapist: Acquitted.
Colleague 2: Acquitted, yes.
Psychotherapist: Or hung.
Colleague 2: That’s right and through the meeting, a third position was found which was one in which he felt responsible and it wasn’t either the one or the other. And I think that’s what made me feel there’s more hopeful, maybe he could go on to treatment, that it wasn’t, he wasn’t just being masochistic.
Colleague 3: But he does seem to have moved, I agree, in the third session to actually being able to say ‘what did I do?’ He does feel guilty about it.
Psychotherapist: Yeah.
This extract was singled out by a fellow psychotherapist, who stated it was ‘one of the most inane and revealing moments in the film … the psychother-apy team discussed the client’s wish to appear on television as a kind of desire for exposure, without attributing the same motives to their own behaviour’ (Feasey 2000: 272). One of the difficulties, of course, is that the psychothera-pists are using specialized psychotherapeutic language (e.g. ‘masochistic’) but the discussion communicates the much simpler idea that the patient is not what he seems and is taking part in the programme for the ‘wrong reasons’.
workIng wIth the vuLneraBLe contrIButor
The existence of such ethical pitfalls ‘place[s] a different burden of respon-sibility on filmmakers who set out to represent others rather than to portray characters of their own invention’ (Nichols 2001: 6). Whatever the reason behind a person’s decision to take part in a television programme, the rights of the contributor are protected under professional codes of conduct. Current UK television production is regulated by the 2005 Ofcom Broadcasting Code and the 2005 version of the BBC Editorial Guidelines, both of which set out appropriate ways of working with programme contributors. In applying these codes to actual production contexts, programme-makers assume that the majority of contributors have the capacity to make an informed decision about participation. The exception is the ‘vulnerable’ contributor: ‘children, older people, those with mental illness, learning disabilities or other cogni-tive impairment (such as sickness or other physical or emotional condi-tions that render the individual unable to think clearly, either temporarily or
permanently)’ (BBC 2005b). This contributor category also includes people who have experienced a tragedy of their own or others’ making and who may not be in a position to protect their own interests. For these people, appearing on a television programme may leave them open to manipulation and exploi-tation (Kennamer 2005). While any programme contributor may experience unexpected and unwanted consequences, it is the vulnerable contributor who faces the greatest risk. Consequently, programme-makers who work with vulnerable people have a responsibility for their care that goes beyond the minimum ethical requirements, particularly where the programme requires them to ‘face challenges of a new kind’ (BBC 2005a).
The voice-over at the start of Talking Cure informs us that the therapy sessions have been recorded with ‘the full consent of those taking part’. The ethical priority for media practitioners engaged in making programmes which feature on-screen psychotherapy is how to ensure that programme contribu-tors have ‘sufficient knowledge … to come to a properly informed decision to agree or refuse’ (BBC 2005b). The challenge for the programme-maker is in identifying what this ‘sufficient knowledge’ should be.
Some issues are likely to be clear from the outset, such as the loss of the right to privacy and the real possibility that whatever has been filmed will be used within the programme. Other issues may not be so clear, but still need to be signalled, such as the possibility that other programme contrib-utors may make comments about them which are perceived to be critical (British Psychological Society 2009a). The programme-maker faces the ethical dilemma of how far to go with identifying possible repercussions. ‘Should we tell someone we film that they risk making a fool of themselves or that there will be many who will judge their conduct negatively?’ (Nichols 2001: 9). In the context of programmes featuring on-screen psychotherapy, should contributors be warned that ‘it is possible, if not likely, that when under stress, they will produce behaviour that they will be embarrassed about and regret’ (British Psychological Society 2009a: 15)?
While Talking Cure presents no ‘extreme’ moments, it does feature instances where programme contributors express their discomfort with what has emerged. An illustrative example comes from the fourth episode (one of the family therapy episodes). The family – father Chris, mum Tracy and child Conor – have just gone through their first assessment session, during which details emerge about Tracy’s medical history (she was told at the age of 15 that she would have difficulty getting pregnant) and Chris’ traumatic childhood.
Voice-over: Tracy did not like her first experience of therapy, especially the interest in their personal histories.
Tracy: I don’t really think going into all our backgrounds had anything to do with it to be honest. It didn’t seem to bother Chris. It bothered me. It really bothered me. Cos I didn’t see how my, especially my personal previous medical history, I don’t see what that had anything to do with why we were there. I really don’t feel that had anything to do with it. I don’t know. Maybe I’m silly but I really don’t – and Chris went into depth talking about it.
Chris: I agree with Tracy. Maybe I did definitely say too much but in a therapy, as for therapy, I don’t think, know if it was needed or not. I’ve come a long way since I was, you know, that little boy on a train and
it’s not really affected me. I’ve never really talked about it before to be honest with you, so …
Interviewer: You didn’t feel that was relevant?
Tracy: I don’t feel that they, that the route of questioning at that time was right. You know if it’s nothing significant, things that are personal to you just should remain personal to you, or kept within the family.
Although it is, arguably, the purpose of psychotherapy to bring out such personal, intimate information, Tracy’s reaction presents the programme-maker with an ethical challenge: should the material she is upset about be included in the programme? This dilemma is heightened further when the material under question is perceived by the programme-maker to be essential to the programme narrative, as was the case in this example. The decision to include the therapy session material that was so upsetting to Tracy is presum-ably meant to be balanced, somehow, by the inclusion of the interview extract where she expresses her discomfort.
While it might be true that any attention experienced in the aftermath of a programme’s broadcast is ‘often short-lived’ (British Psychological Society 2009a: 18), the experience of having intimate information publically aired and discussed in a negative and uncomplimentary light is another consequence of television programme participation. Some of the reviews of the series contained derogatory comments, such as the remark by one critic about the supposed ‘lack of embarrassment shown by the volunteers on The Talking Cure … whom the BBC has persuaded to have their psychotherapy filmed in Kleenex-crunching detail’ (Billen 1999). Another commented on the thera-peutic exchanges between the psychotherapist and Jan, the contributor in the first episode, in which the psychotherapist was reported to have
stopped short of telling him to get a haircut and pull his socks up, but you felt it was a near run thing. And to be frank, she would have had my sympathy. That probably wasn’t the reaction the programme was after. Still, fun is fun: I enjoyed it.
(Hanks 1999)
Negative, personal remarks were not confined to the columns of television critics either. One psychotherapist wrote that ‘[t]here were echoes of narcis-sism in the first “patient,” if we can call him that’ (Wessely 1999: 1444). Nor were the psychotherapists exempt. The psychotherapist in the first episode was described as ‘a terrifying, posh witch-woman who is viciously mean to him and accuses him of flirting with her’ (McGill 1999).
duty of care
In television programmes which feature on-screen psychotherapy, the unusual situation arises where two groups of professionals – programme-makers and psychotherapists – have a duty of care towards the programme contributors who undergo the psychotherapy. While their respective ethical frameworks have common core values, there are differences which may have implications for the care of the vulnerable contributor.
One shared requirement, at least in the NHS context, is that patients must be referred by their doctor for psychotherapeutic assessment. The Talking Cure
voice-over states that those who were selected to be patients (who had, in the first instance, responded to advertisements posted by the programme-makers) were required to obtain such a referral before involvement with the programme production could continue. This requirement is mirrored in current broadcasting guidelines, which require that evidence be obtained to demon-strate that vulnerable contributors are ‘medically fit and psychologically robust enough to take part in filming’ (BBC 2005a). Medical referrals have a twofold effect: they authenticate the patient’s ‘need’ for psychotherapy and provide important ‘backstory’ for the psychotherapist who will conduct the assess-ment. In Talking Cure, there are references to an additional questionnaire completed by patients before the assessments. The information that emerges has benefits for both the media practitioner and the psychotherapist.
Both groups have a responsibility to highlight the likelihood that the psycho-therapy will be a difficult and challenging experience. Towards the end of the first episode of Talking Cure, when it is revealed that the patient has been offered long-term psychotherapy at the Tavistock, the psychotherapist tells him,
look, if you take this further and go into regular treatment here, which I certainly think is a good idea and we can offer you, if you do that it’s not going to be easy … because you’ll get depressed, you’ll get miserable … you can feel pretty bleak in between sessions.
However, the lack of confidentiality and the level of public exposure associ-ated with on-screen psychotherapy means that programme-makers must go further: not only is the contributor agreeing to engage in a difficult, challeng-ing activity but they are agreeing to be filmed and for the resulting footage to be broadcast. This is one reason why broadcasting guidelines stipulate that appropriate levels of aftercare be provided, particularly at the time of broadcast (BBC 2005a). In the case of Talking Cure, the voice-over states that long-term psychotherapy was offered to any programme contributor who needed it. The voice-over goes onto report that this happened only in the case of the contrib-utor in the first episode, ‘because talking about the car crash revealed pre-existing emotional difficulties, not all of which could be covered by the film’.
One area of difference between the two professional groups relates to the claim that programme-makers often ‘enter intimately into people’s lives and then withdraw suddenly when the project comes to an end’ (British Psychological Society 2009a: 18). This concern is addressed in the professional guidelines for working with vulnerable contributors, which state that it is
advisable to stay in close contact with contributors … in order to moni-tor their situation and offer support or help where necessary; however, we also need to be clear about the limits of any assistance we can offer and the time frame within which we can offer it.
(BBC 2005a)
In the case of Talking Cure, the production process lasted for around 2 years. Media practitioners who work on long-term projects develop a different kind of relationship with their contributors to those who work on programmes with a quick turnaround. ‘I am in their life for a whole year. So there is a more profound relationship, not a journalistic two or three hours’ (Aufderheide, Jaszi and Chandra 2009: 7). In any event, it is not unusual for production companies to set up independent psychotherapeutic support for vulnerable
contributors who have taken part in programmes. It has been argued that the involvement of psychotherapists in the programme-making process is used by broadcasters as a ‘robust defence against charges of exploitation, [giving] the appearance that a production’s concern for its participants’ welfare is more than glancing’ (Brenton and Cohen 2003: 92). While this may be true, the involvement of psychotherapists does secure for the vulnerable contribu-tor additional ethical protection.
unexpected consequences: an exaMpLe froM Talking Cure
The third episode of Talking Cure explores the Tavistock Clinic’s work with organizations, in this case a Welsh primary school. The school’s head teacher responded to an advertisement in The Times Educational Supplement which offered head teachers help in managing stress and change (Wallace 1999). The voice-over at the start of the episode states ‘the consequences took everyone by surprise’, followed by an extract from an interview with the psychothera-pist involved in the programme, who states that ‘you could look at it and say here’s a perfectly functioning school, a model for the world. The man from the Tavistock comes in and three months later look at what a mess they’re in’.
This programme opening illustrates how the programme-makers show-case their most powerful and dramatic material. The remainder of the episode, like the rest of the series, is structured in a linear fashion around the assess-ment sessions. Initially, head teacher Roger visits the Tavistock to meet the psychotherapist. One month later, the psychotherapist visits the school to conduct the first assessment session with Roger and the other teaching staff.
The difficulties arising from the therapeutic intervention are evident from the very first visit. On a tour of the school, the psychotherapist observes that ‘the impression one gets is of young enthusiastic women … then you … so the male female issue at some level must be an important one’. In the team meet-ing, after some discussion about workloads and the apparent hopelessness of their situation, the psychotherapist brings the discussion around to Roger. Unlike the assessment sessions which took place at the Tavistock Clinic, there appears to be a camera crew present.
Psychotherapist: I was wondering, and I’m saying this partly with tongue in cheek, I wonder whether part of the problem isn’t Roger? [off-camera laughter] That he’s so proud of the school and, you know, has worked so long and so hard that with a head like this, you know, one feels one has to work to one’s maximum capacity even though at another level, perhaps, you recognize that it’s too much?
The next sequence shows the ensuing discussion between the psychotherapist and the teaching staff, during which Roger is mainly silent. The psychothera-pist asks how the school would cope if Roger left. While the teachers respond, the camera pans across to Roger, zooms in a little and holds the shot while the psychotherapist and teachers continue to talk (Roger remains silent). While it would be unwise to infer Roger’s thoughts and feelings from this shot alone, the impression created through the filming and editing of this sequence is that Roger is not only uncomfortable but aware that the camera may have singled him out and is ‘waiting’ for a reaction. This sequence is followed by an extract from an interview with the psychotherapist, recorded at a different point in the production process.
Psychotherapist: So you do have a dynamic of a substantially older man and a lot of younger women, which in part explains what goes on. There’s a male female dynamic. I think there is a dynamic if you want to see it symbolically of the father and his family or the father and his daughters … Now at some level it’s a nice dynamic because the daughters adore dad and dad adores the daughters and it makes for a good comfort-able situation but at another level it also makes for a stuck situation.
Shortly after this, there is a sequence featuring school assembly led by Roger, while the other (female) teachers are shown sitting around the edge of the hall. A sound-only extract from an interview with the psychotherapist states that ‘[t]here are certain risks to having charismatic leaders. One had the feel-ing that the entire school is dependent on his personality.’
After a brief hiatus, the psychotherapist returns for a second visit. The psychotherapist and teachers wait for Roger, who is called to another meet-ing and does not attend. The teachers speak openly, if tentatively, about their unhappiness about Roger’s frequent absences.
Psychotherapist: It’s an opportunity to speak perhaps while Roger’s not here … this is not the nature of a personal complaint against Roger. Obviously it’s pretty important to perhaps feedback to Roger how you really feel about this. The difficulty seems to be that he is so nice and so popular that it’s somehow difficult … In a way he’s done us a favour by being absent today so that we can talk about it and I very much hope you’ll feedback to him the discussion.
The teachers seem uneasy. The psychotherapist picks this up, pressurizing them to raise their concerns with Roger. At this point, Roger returns.
Psychotherapist: So the question was, I was just about to encourage them to actually address this issue with you and say ‘well perhaps he doesn’t understand what effect this has’ and they were saying ‘but if he didn’t go out he’d be bored’. So, there was that to it and we also spoke about whether one could get a replacement for you in the sense of hours or supply teaching and so on. So it was at this hot awkward point [laughter all round, including Roger] that you arrived. So what have you got to say for yourself? [more laughter]
Roger rather stiffly defends his attendance at external meetings, arguing that ‘unless you are prepared to play your part in the consultation process, there is no voice for school like ours’. The psychotherapist continues.
Psychotherapist: Certainly the feel I picked up, perhaps wrongly, is that it felt very much as if you were an absentee daddy a lot of the time you were out in the exciting world with the glittering lights doing [off-camera groans] doing – I’m exaggerating a little to make a point – doing important things out there while, you know, they were left at home dealing with the everyday laundry and other difficulties.
After Roger defends his actions once more, the psychotherapist concludes with the statement that ‘perhaps the result of this consultation will be that you’re just going to have to live with it, this is the reality of how life is’. The teachers
respond fatalistically, including Roger, who states flatly, ‘I just can’t carry on like this because the pressures on me personally are just too great’. This sequence is followed by an extract from an interview with the Deputy Head.
Deputy Head: I think we all felt bad. You know, he asked us our views on Roger and we just said that we needed him here and the way it came out, it didn’t come out quite like that so that when Roger came in it really looked bad and we all, every one of us, went to him the next morning, because he only came in the next morning, and he just wasn’t right at all. He said he didn’t blame us, he didn’t blame anything, perhaps it was just highlighted, the conversation, I don’t know but we haven’t seen him since.
The voice-over confirms that Roger went on long-term sick leave. The programme-maker then interviews the psychotherapist.
Interviewer: Have you actually helped Roger?
Psychotherapist: [long pause] I think the answer is yes but whether he himself thinks so, or whether the school thinks so, is another matter.
The programme voice-over provides some information about what happens to Roger after this. His sick leave continued for 6 months, during which time he visited the Tavistock for a final filmed session with the psychotherapist. During this session, he reports that although he has tried to go back to work, he ‘cannot cope any longer’. However, in an article in The Times Educational Supplement, published at the time the episode was broadcast, it is revealed that Roger did go back to work, ‘[h]elped not only by his interactions with [the Tavistock psychotherapist] but also with the county medical officer – a psychology specialist – and his GP’ (Wallace 1999).
The complexities of this example demonstrate that it is no simple matter according responsibility for such unexpected and unwanted consequences. Some programme critics laid the blame squarely at the feet of the psycho-therapist. ‘I felt that what … [the psychotherapist] was doing was stirring … He invites [Roger’s] loyal staff to say undermining things about him … But to what effect? [Roger] collapses like a tent with its pegs pulled out’ (Kellaway 1999a). Another remarked that ‘[a]fter making some unhelpful father–daughter comparisons that left the head … looking like a King Lear with-out a Cordelia, [the psychotherapist] … deliberately hyped his female staff’s complaints against him’ (Billen 1999). Others, undoubtedly, would blame the Tavistock for having embarked on the project in the first place. Does Roger carry any responsibility, having invited the media into his workplace? What about the programme-makers who will surely have recognized, as filming progressed, that they had the material for a programme which would make such ‘riveting viewing’ (Wallace 1999)?
concLusIon
Just as the consequences of engaging in psychotherapy cannot be predicted, nor can the consequences of participating in a television programme. In programmes which feature on-screen psychotherapy, these two activities combine to form a high-risk pursuit which is overseen by the individual media practitioner. The ultimate responsibility for the programme contributors who
undergo on-screen psychotherapy lies with programme-makers (and broad-casters), because it is they who control how filmed psychotherapy is structured and used as programme content. This control exposes media practitioners to a complex set of ethical dilemmas which must be negotiated if they are to protect the rights of the vulnerable programme contributor. Whether this approach is compatible with the production of ‘riveting’ television is another matter. While there is no published evidence that Talking Cure contributors reacted negatively to their experience – in fact, the Tavistock reports that ‘the patients felt that what was shown of their interviews in the programmes was respectful of them’ (Temple 2000) – this research has shown that there are moments within the programme when contributors faced unexpected consequences as a result of their participation. An effective ethical code of conduct guides media practitioners in their work and highlights the poten-tial power imbalances that may arise between the film-maker, subjects and their audience (Nichols 2006). Media practitioners who make programmes which feature on-screen psychotherapy face unique ethical challenges, which may only be resolvable in ad hoc best-case-scenario ways. How much warn-ing should be given? So much that contributors pull out of the programme? So little that contributors are exposed to unwanted consequences? This arti-cle has considered these questions through an analysis of a television series which confronts these questions and in doing so exposed the ethical pitfalls which await media practitioners who work on this kind of programme.
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suggested cItatIon
Blaker, L. (2013), ‘It’s good to talk? Talking Cure and the ethics of on-screen psychotherapy’, Journal of Media Practice 14: 3, pp. 193–209, doi: 10.1386/jmpr.14.3.193_1
contrIButor detaILs
Lesley Blaker is a Lecturer in Creative Media at the University of Salford’s MediaCityUK campus. She has a background in television production and post-production, and supervises final-year documentary projects on the Television & Radio degree. She is in the process of completing her doctoral thesis on televised psychotherapy.
Contact: University of Salford, MediaCityUK Plot B4, Salford Quays, M50 2HE, UK.E-mail: [email protected]
Lesley Blaker has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as the author of this work in the format that was submitted to Intellect Ltd.
Intellect is an independent academic publisher of books and journals, to view our catalogue or order our titles visit www.intellectbooks.com or E-mail: [email protected]. Intellect, The Mill, Parnall Road, Fishponds, Bristol, UK, BS16 3JG.
Explorations in Media Ecology
ISSN 15397785 | Online ISSN 20480717
4 issues per volume | Volume 12, 2013
EME explores the relationships between media, technology, symbolic form, communication, consciousness, and culture. Its scope is interdisciplinary and multidisciplinary. Media ecology provides a rich philosophical, historical and practical context for studying our increasingly technological and medi-ated society and culture with an emphasis on historical context.
Media ecology scholarship emphasizes a humanistic approach to under-standing media, communication, and technology, with special emphasis on the ways in which we have been and continue to be shaped and influenced by our inventions and innovation. The Media ecology approach is predicated on understanding that media, symbols, and technologies play a leading role in human affairs, and function as largely invisible environments affecting the way we think, feel, act, and organize ourselves collectively.
Explorations in Media Ecology (EME) is the Journal of the Media Ecology Association
